Solo Seniors: what are you doing to plan for the possibility of dementia/alzheimer's?

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Fremdon Ferndock
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Solo Seniors: what are you doing to plan for the possibility of dementia/alzheimer's?

Post by Fremdon Ferndock »

I'm a senior citizen with no children. My mother developed dementia in her 80s and I've seen that happen to other family members and people I know. I realize the time has come for me to do everything I can to get things in order, particularly my finances, in order to be prepared for the real possibility this could happen to me in the next few years. Better safe than sorry. Like to hear from others who have been navigating this same journey. I'm trying to harvest as much information and ideas from others as possible.
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Taxholiday
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Re: Solo Seniors: what are you doing to plan for the possibility of dementia/alzheimer's?

Post by Taxholiday »

Not a solo senior, but we are navigating these decisions currently for my mother-in-law. She was diagnosed with Lewy body dementia early this year and has experienced a rapid decline cognitively and now physically. First, it is really wise to consider this early, perhaps by necessity, since you are looking out for yourself. My in-laws were both very much unprepared and the family has had to react rather than plan. It's been very challenging for my father-in-law emotionally and he is not up to the (overwhelming) task of developing a plan for her care at this point. Most of the logistics in finding a solution has fallen to my spouse.

My in-laws were good savers, but they worked in government and charitable organizations for their careers. Ultimately, we've found them a continuing care retirement community (CCRC is what they're called in NJ) that offers a 'home for life' type guarantee. These communities allow you to transition from independent living, to memory care, to long term care and offer various services in between to accommodate both spouses. In many respects, the path was more difficult because my in-laws are on different trajectories (FIL is independent; MIL requires memory care or longterm care already). It would actually be easier to navigate planning for one from a cost perspective.

CCRC's (here anyway) have a partially refundable buy-in deposit. My in-laws have liquidated some funds to cover the deposit (which is the cost of a home) and will sell their home to recover that once my FIL can move into his apartment. Basically, a trade of housing equity for the right to live in the community with assurances they can transition levels of care as needed. MIL's care level is still TBD, and they may end up spending everything to cover the cost of care - the buy-in deposit doesn't eliminate monthly costs (which are in the high 10's of thousands for someone with Lewy body needing 24/7 care). However, if they do spend everything on my MIL's care, they community will first start charging agains their deposit. Then, if that's exhausted, we know my FIL will still have a home for life (and be able to transition levels of care if he later needs). I'd add that this is not a Medicaid type situation, my in-laws' financials were reviewed and approved (about $2m including home). They are not yet 70, and I interpret the community is (for lack of better term) betting they will not exhaust their assets (because my MIL is not likely to live for very long at this level of care).

I hope that is useful information. It is very difficult to plan for these issues because the variability in future care needs is not knowable. My main point is that it is very smart to think about this while you are able to plan on your own behalf. If you are able to find a similar type of community where you are, it may be an appropriate plan because it offers flexibility. To end on a positive note, the community is absolutely a wonderful place to live for seniors in independent living (hopefully, you never need higher levels of care). Equally important, it offers peace of mind you will have elevated care if you need to leave independent living.
WillRetire
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Re: Solo Seniors: what are you doing to plan for the possibility of dementia/alzheimer's?

Post by WillRetire »

My great aunt, widowed & with no children, moved herself out of her house and into a senior residence. By the time I visited, I think she had moved up to assisted living, and the dementia was noticeabe. She was an intelligent woman who prided herself in getting things done without fuss and on her own. Much to her credit.

Spouse & I have visited multiple CCRCs and independent living places. We're on the waiting lists for the ones we like. Not quite ready to make the move yet. We observe that amongst our elderly relatives living and deceased, age 80 is the inflection point; they go down hill fast after that, and any move is difficult and traumatic. That's our family tree. Other lucky people are able to live independently into their 90s and still drive. We don't expect that for ourselves. We plan to be out of our house and in a senior residence by age 80-82. We will make the arrangements ourselves & hire movers to pack & move us.

We wrote a letter of instruction to remind ourselves of these plans, and to help the survivor think straight if one of us passes sooner than expected.

My advice is:
1. Start visiting independent living places & CCRCs to get an idea of cost & what you like. Take notes. Many places have a memory care unit as well as assisted living & skilled nursing.
2. Create, sign and date a letter that outlines what you want to do, where you want to go, where you have made deposits. Keep the letter with your other estate planning docs so that if you are incapacitated, your wishes will be known.
GAAP
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Re: Solo Seniors: what are you doing to plan for the possibility of dementia/alzheimer's?

Post by GAAP »

Not solo so far -- and I do have kids, so hopefully this concern won't arise.

The biggest issue I see is not so much how to pay for the care you might need, but how to ensure that you get it when your reasoning processes are no longer reliable. I suggest looking for someone to act in that regard -- and make sure that they don't have a financial incentive to lie about it.
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WillRetire
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Re: Solo Seniors: what are you doing to plan for the possibility of dementia/alzheimer's?

Post by WillRetire »

We have estate docs naming each other as POA(s). You'll want to work with an elder law attorney to prepare similar legal documents, if you haven't already. When one of us passes or becomes incapacitated, we'll need to revisit & name another person.

I think becoming members of a senior community will become very important to us as things progress.
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Re: Solo Seniors: what are you doing to plan for the possibility of dementia/alzheimer's?

Post by Wilderness Librarian »

Almost 70. At 55 bought long term care insurance for self telling agent I wanted terms & pricing so I could receive care at home if at all possible. Too many uncertainties/variables to plan a whole lot more at this point. I have reletives in immediate area but don't know who will be living near me (or frankly may predecease me or need extensive care before I do. I live in family home I inherited from parents - I can walk to many food & medical places. I know this doesn't solve anything but it may mean I can remain semi-self dependent longer. There are managed care places nearby don't know terms or costs.
TN_Boy
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Re: Solo Seniors: what are you doing to plan for the possibility of dementia/alzheimer's?

Post by TN_Boy »

Wilderness Librarian wrote: Tue Jun 21, 2022 1:17 pm Almost 70. At 55 bought long term care insurance for self telling agent I wanted terms & pricing so I could receive care at home if at all possible. Too many uncertainties/variables to plan a whole lot more at this point. I have reletives in immediate area but don't know who will be living near me (or frankly may predecease me or need extensive care before I do. I live in family home I inherited from parents - I can walk to many food & medical places. I know this doesn't solve anything but it may mean I can remain semi-self dependent longer. There are managed care places nearby don't know terms or costs.
Having LTCi may -- or may not -- be a good financial move, but we've had plenty of threads on LTCi. You definitely want your LTCi to pay for some in-home care. If you need 24x7 care at home, the daily cost will blow way past the daily limits on the LCTi.

Relevant to this thread, LTCi actually increases the work for someone managing your affairs. That person now has to deal with both the care facility and the LTC company. It's usually not a big deal, but it's one of those "have to handle that also" tasks. Versus just .. paying for the care.

Also relevant to this thread, even a person with children might be in a similar situation to the single person. If the children live far away -- different country or even west versus east coast USA -- they will NOT be in a position to properly manage your care if you cannot. Unless somebody moves. The remote child might be able (by taking time off from work, etc) to handle periodic emergencies, but they cannot make sure all is well without being local. If you have a frail elder in assisting living or a nursing facility, especially if they have dementia, somebody needs to be monitoring the situation weekly at the least. Something to consider. This is why children often want their aging parent to move near them (which is difficult and stressful for the parents) because managing someone's affairs remotely is difficult. Actually, it is impossible to do well once much decline sets in.

You must have local advocates.
Last edited by TN_Boy on Tue Jun 21, 2022 2:22 pm, edited 1 time in total.
cs412a
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Re: Solo Seniors: what are you doing to plan for the possibility of dementia/alzheimer's?

Post by cs412a »

My son has POAs for healthcare and finances, and I've left written instructions as to how he is to draw down the funds if/when I become incapacitated (e.g., through a stroke or Alzheimer's). I am in the process of identifying good assisted living and nursing home options both locally (small city/rural area) and in the larger metropolitan area where my sisters currently reside. I expect to sign up for waiting lists for assisted living when I'm in my early 80s, since in my family the cut-off for being able to live independently has tended to occur after the age of 85. Of course, that's not guaranteed.

So in the meantime, I participate in the Alzheimer's Prevention Trials (APT) study (which I learned about through the Bogleheads forum). Although the name of the study suggests that participation prevents Alzheimer's, it doesn't do that. Rather, the purpose of the study is to identify individuals with cognitive decline to provide a subject pool for research studies investigating new treatments for Alzheimer's disease. From my perspective, participation allows me to track basic cognitive performance over time so that I'll be able to spot more subtle declines in cognitive function, which should allow me to take steps to deal with the prospect of further decline.

There are 4 basic cognitive tasks:

A detection task measures information processing speed. The participant views a series of playing cards on the screen. When a card turns over, the participant must then press the “Yes” key as quickly as possible.

An identification task measures visual attention. The screen shows red or black joker cards flipping over, and participants press the a key as quickly as possible (one key for “yes” if the card red, another key for “no” if the card is black).

A learning task measures visual learning and short-term memory. A series of playing cards is flipped over on the screen one at a time. Each time a card is revealed, the participant must then respond “Yes” or “No” to indicate whether that card has been previously shown at any time during the task.

The one back task measures attention and working memory. A series of playing cards is flipped over on the screen one at a time. When each card is revealed, the participants responds “yes” or “no” to indicate whether the card is the same as the previous card.

It's important to note that while a participant will receive information on their performance, it's only possible to compare earlier to later performance, not how one performs relative to other individuals of the same age. I don't have a problem with that since I'm only interested in tracking my own performance over time.

I have to admit, however, that even though my performance over the past few years has been very stable - and I'm very familiar with the nature of these tasks since I have done research on cognition and cognitive development - I find the process of taking the tests anxiety provoking. So it's not for everyone.
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Re: Solo Seniors: what are you doing to plan for the possibility of dementia/alzheimer's?

Post by Tib »

I'm in the same boat as the OP. It's a tough one even when there are plenty of assets. And now, of course, our assets are diminished, especially relative to prices, for who knows how long. Even if we eventually move to some sort of senior facility, there may well come a time when our finances, taxes, decisions, and so on must be handled by others. I wouldn't want to burden, pay, or trust others and wouldn't want the progressively greater indignities of assistance with the ADLs. I have a plan, but it'll take some luck to avoid that ghastly denouement.
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Re: Solo Seniors: what are you doing to plan for the possibility of dementia/alzheimer's?

Post by backpacker61 »

I would start with having a will drafted, with Medical POA and Durable POA. Also Advanced Medical Directives. The Durable POA will designate someone to handle your affairs in the event that you are no longer able to do so. Mine is a bank trust department at a bank I trust, and that handles this type of thing quite a lot (hint: you probably don't want to use one of the "big banks" for this).

Another step I would take would be to consolidate your financial assets down to a very small number of providers; perhaps one bank and one or two brokerage accounts (fewer generally being better). What you really don't want is to have CD's with a half a dozen different banks all over town just to get a little better CD rates or remain under the 250K FDIC limit; you may forget about these scattered accounts as you get older. Consider brokered CD's in your brokerage account instead.
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Re: Solo Seniors: what are you doing to plan for the possibility of dementia/alzheimer's?

Post by fposte »

I've got my eye on a local CCRC and am aiming to move in at @70, in ten years; I am hoping to find a good geriatric case manager along the way as an extra layer of external vigilance. Having a pension that I can't simply cash out is another piece of security, since it limits the damage I can do if my thinking is affected.

Of course, the problem is that dementia doesn't obligingly wait until you're set for it; I have a good friend whose husband developed early onset at around 55, and support for pre-Medicare age dementia is frighteningly limited, especially if Medicaid is needed. So I'm rolling the dice to some extent.
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Re: Solo Seniors: what are you doing to plan for the possibility of dementia/alzheimer's?

Post by neowiser »

Hiring a professional fiduciary is one option. A fiduciary is someone who does almost everything a close family member would do, for a fee. Here is a website with a good description of fiduciary services and suggested questions to ask prospective fiduciaries: https://quinnfiduciaryservices.com/

There is a national fiduciary association with a directory but it may not be the best resource (https://nationalcffassociation.org/). A bank trust department or local estate attorney may be able to provide better referrals to fiduciaries. The fiduciary may be able to suggest the best way to prepare for incapacity, such as creating a trust and designating the fiduciary as successor trustee.

Dementia is hardest on caregivers, the people I've known who had dementia were not particularly suffering to the point that they even considered ending their lives. They "lived in the moment" and as long as the moments were pleasant they seemed happy. A board and care home or quality memory care facility can provide a comfortable place to live out remaining years.
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Re: Solo Seniors: what are you doing to plan for the possibility of dementia/alzheimer's?

Post by ResearchMed »

TN_Boy wrote: Wed Jun 22, 2022 12:11 pm The big problem with a true solo senior, as I see it, is what person will be your advocate when you cannot be? This ranges beyond getting someone to write checks for the bills. Who talks with the doctors when you are not able to make decisions and evaluates the range of medical options? Who visits you when you are in a care facility and makes sure the right things are happening? Etc. As I mentioned, even people with kids can have this problem if the kids are far away. I don't have an answer at the moment ... but from what I've seen having somebody local with the time and desire to help out is the biggest unique "solo senior" problem.

Except in rather unusual circumstances, approximately half of those currently "not solo" will land in that category at some future time. And in some cases, both will be needing advocates...

So everyone should plan accordingly, regardless of what that plan is.

RM
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Re: Solo Seniors: what are you doing to plan for the possibility of dementia/alzheimer's?

Post by DetroitRick »

While we are a married couple, we assume one of us will be solo and are planning accordingly. For all the limitations of old age, not just dementia.

We've just started meeting with firms to find contingent professional fiduciary services. Our initial meeting last week, was with a firm much as neowiser listed above in their first link (also a fiduciary, offering all those services except the geriatric management services). My initial impression was that they could handle much of what one or both of might need - from investment management, trustee services, taxes, paying bills, etc. Better than friends or family. But of course, not cheaper.

This particular company came to us via a conversation I had with our Schwab rep. I suspect we will talk to a few more similar firms before making a (non-permanent, of course) decision. At least these type of fiduciary services seem to be increasing in number and in basic scope of services (or I just never noticed because I was too young, who knows?). Anyway, these services are available.

We managed all of this for wife's mom, until her passing in January. Home care, nursing home, finances, bill paying, taxes, insurance management, etc. For us, the geriatric management part was the toughest, and the available resources fairly inferior. The rest could easily have been farmed out if desired. But at a cost.

This is a work in progress for us too. All our decisions have yet to be made. Best of luck in your search.
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Re: Solo Seniors: what are you doing to plan for the possibility of dementia/alzheimer's?

Post by TN_Boy »

ResearchMed wrote: Wed Jun 22, 2022 12:25 pm
TN_Boy wrote: Wed Jun 22, 2022 12:11 pm The big problem with a true solo senior, as I see it, is what person will be your advocate when you cannot be? This ranges beyond getting someone to write checks for the bills. Who talks with the doctors when you are not able to make decisions and evaluates the range of medical options? Who visits you when you are in a care facility and makes sure the right things are happening? Etc. As I mentioned, even people with kids can have this problem if the kids are far away. I don't have an answer at the moment ... but from what I've seen having somebody local with the time and desire to help out is the biggest unique "solo senior" problem.

Except in rather unusual circumstances, approximately half of those currently "not solo" will land in that category at some future time. And in some cases, both will be needing advocates...

So everyone should plan accordingly, regardless of what that plan is.

RM
Absolutely, but often children do fulfill the required role. Certainly I did for my parents. And that is quite common.

A single person with no children (or estranged children, or children far away with their own problems ...) may struggle with who will fulfill the potentially very very timeconsuming caretaking/manage care/look after older person role. That's the piece that while it may not be unique to the "solo senior" is perhaps more likely to be an issue for that person.
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Re: Solo Seniors: what are you doing to plan for the possibility of dementia/alzheimer's?

Post by Lee_WSP »

The "best" plan I have been able to come up with is a CCRC. Even if you have a spouse, a CCRC is still one of the better options as it provides a safety net if your decline is "bad". Relying on your spouse to take care of you places a burden on them, so it's actually a lot easier of a plan than if you weren't solo.

I likewise do not recommend anyone rely upon their children to do it either. Dementia is a horrid disease and its effects range from benign to outright shocking. The end result is always the same. Partial or full assisted living will be necessary.

Medicaid protection trust planning may or may not factor in. Planning your finances is going to be pretty individualized and will depend on a lot of factors.
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Re: Solo Seniors: what are you doing to plan for the possibility of dementia/alzheimer's?

Post by FreddieFIRE »

Lee_WSP wrote: Wed Jun 22, 2022 6:34 pm I likewise do not recommend anyone rely upon their children to do it either. Dementia is a horrid disease and its effects range from benign to outright shocking. The end result is always the same. Partial or full assisted living will be necessary.
What is the "it?" Is it managing the elderly's affairs or actually providing daily care?
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Re: Solo Seniors: what are you doing to plan for the possibility of dementia/alzheimer's?

Post by Lee_WSP »

FreddieFIRE wrote: Wed Jun 22, 2022 6:47 pm
Lee_WSP wrote: Wed Jun 22, 2022 6:34 pm I likewise do not recommend anyone rely upon their children to do it either. Dementia is a horrid disease and its effects range from benign to outright shocking. The end result is always the same. Partial or full assisted living will be necessary.
What is the "it?" Is it managing the elderly's affairs or actually providing daily care?
The care.

The finances are easy. A trust company if you have the assets. A private fiduciary if you don't. This is my advice even if you have children unless they're very financially savvy. Also, my advice if your spouse may not be up to the task.
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Re: Solo Seniors: what are you doing to plan for the possibility of dementia/alzheimer's?

Post by whodidntante »

If you have Amazon Prime, watch Episode 2 for helpful tips. Or at least some yucks.
https://www.amazon.com/gp/video/detail/ ... lZOsi7_2_1
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Re: Solo Seniors: what are you doing to plan for the possibility of dementia/alzheimer's?

Post by delamer »

As others have suggested, investigate moving into a continuing care retirement community (CCRC).

There often are waiting lists for the best facilities so the sooner you find one you like and put down a deposit, the better.

Plus you are a more attractive resident if you move in before you need any assistance due to dementia or other conditions.
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Re: Solo Seniors: what are you doing to plan for the possibility of dementia/alzheimer's?

Post by FreddieFIRE »

Lee_WSP wrote: Wed Jun 22, 2022 6:53 pm
FreddieFIRE wrote: Wed Jun 22, 2022 6:47 pm
Lee_WSP wrote: Wed Jun 22, 2022 6:34 pm I likewise do not recommend anyone rely upon their children to do it either. Dementia is a horrid disease and its effects range from benign to outright shocking. The end result is always the same. Partial or full assisted living will be necessary.
What is the "it?" Is it managing the elderly's affairs or actually providing daily care?
The care.

The finances are easy. A trust company if you have the assets. A private fiduciary if you don't. This is my advice even if you have children unless they're very financially savvy. Also, my advice if your spouse may not be up to the task.
Thanks. I certainly agree about the care. I would never expect my spouse to handle the finances on her own, but am fortunate to have responsible adult children who have learned Boglehead since their teen years. I'm thankful for that.
FIRE?? Just call me "Ready Freddie."
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Re: Solo Seniors: what are you doing to plan for the possibility of dementia/alzheimer's?

Post by TimeRunner »

Lee_WSP wrote: Wed Jun 22, 2022 6:34 pm The "best" plan I have been able to come up with is a CCRC. Even if you have a spouse, a CCRC is still one of the better options as it provides a safety net if your decline is "bad". Relying on your spouse to take care of you places a burden on them, so it's actually a lot easier of a plan than if you weren't solo.

I likewise do not recommend anyone rely upon their children to do it either. Dementia is a horrid disease and its effects range from benign to outright shocking. The end result is always the same. Partial or full assisted living will be necessary.

Medicaid protection trust planning may or may not factor in. Planning your finances is going to be pretty individualized and will depend on a lot of factors.
I manage my elderly Mom's caregiving, healthcare, finances, grocery & supplies shopping, condo maintenance, etc. She wanted more than anything to be able to live out the rest of her life in her condo rather than a facility, and this was after turning down various CCRCs that would have been closer to us than the 85 miles she is from us now. She's living her best life only because she can afford the very expensive 24/7/365 care that's required for her dementia and the problems that come with being 93 and preferring a "bed-centric lifestyle". Although I have everything optimized and as simple as can be arranged, it still takes a fair amount of time almost every day to keep everything on track.

My wife and I were DINKS, so our solution is to be waitlisted at a high quality CCRC that we feel will meet our needs. The waitlist won't get to us for about four years, after which we will hopefully turn down 'offers' for the next six or eight years, assuming we stay healthy enough in the meantime. While that's a bit of a gamble, our lifestyle and family history is such that, accidents aside, we have an excellent chance of still qualifying ten or twelve years from now. In the meantime, we remodeled our current house last year with an eye towards making it 'age-in-place' friendly, so if we had to stay in our house, it's the right size in an excellent location with the right features to allow us to do that, and it hopefully won't require any major maintenance since we replaced the HVAC, roof, plumbing fixtures, etc in the remodel. It should also be easy to sell if/when we do the move to the CCRC.

I haven't yet explored in any depth the issue around finding a fiduciary/trust company, but they are around. It's on my low priority to-do list.
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Re: Solo Seniors: what are you doing to plan for the possibility of dementia/alzheimer's?

Post by TN_Boy »

Lee_WSP wrote: Wed Jun 22, 2022 6:53 pm
FreddieFIRE wrote: Wed Jun 22, 2022 6:47 pm
Lee_WSP wrote: Wed Jun 22, 2022 6:34 pm I likewise do not recommend anyone rely upon their children to do it either. Dementia is a horrid disease and its effects range from benign to outright shocking. The end result is always the same. Partial or full assisted living will be necessary.
What is the "it?" Is it managing the elderly's affairs or actually providing daily care?
The care.

The finances are easy. A trust company if you have the assets. A private fiduciary if you don't. This is my advice even if you have children unless they're very financially savvy. Also, my advice if your spouse may not be up to the task.
I wouldn't recommend children take on daily caregiving itself, unless there is literally no other option. Many children do this, because other options are not available.

But there is still a lot of potential work managing a parent's health issues, housing issues, visiting etc. Such work might not be called "caregiving" but it is important, and can be quite time consuming. This need does not go away even if the parent winds up at the best care facility on the planet. An advocate is needed.

What does it cost to have a trustee or private fiduciary manage finances? I'm curious about "The finances are easy" statement.

I would say that if your children are not up to the task of managing the finances, and if they are willing and able to provide other support, then time should be spent educating them on the finances. I say this because I found that managing parental issues was often tied to finances. I needed to know and understand what $$ were available to help make caregiving choices for example. I think it would have been time consuming and frustrating to have to work through a trust company. But maybe that's what people with lots of money do. My parents were far from poor, but they had no such arrangements. I had a global view (finances and health issues, etc) which was important, I think.
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Re: Solo Seniors: what are you doing to plan for the possibility of dementia/alzheimer's?

Post by Lee_WSP »

TN_Boy wrote: Wed Jun 22, 2022 7:24 pm
Lee_WSP wrote: Wed Jun 22, 2022 6:53 pm
FreddieFIRE wrote: Wed Jun 22, 2022 6:47 pm
Lee_WSP wrote: Wed Jun 22, 2022 6:34 pm I likewise do not recommend anyone rely upon their children to do it either. Dementia is a horrid disease and its effects range from benign to outright shocking. The end result is always the same. Partial or full assisted living will be necessary.
What is the "it?" Is it managing the elderly's affairs or actually providing daily care?
The care.

The finances are easy. A trust company if you have the assets. A private fiduciary if you don't. This is my advice even if you have children unless they're very financially savvy. Also, my advice if your spouse may not be up to the task.
I wouldn't recommend children take on daily caregiving itself, unless there is literally no other option. Many children do this, because other options are not available.

But there is still a lot of potential work managing a parent's health issues, housing issues, visiting etc. Such work might not be called "caregiving" but it is important, and can be quite time consuming. This need does not go away even if the parent winds up at the best care facility on the planet. An advocate is needed.

What does it cost to have a trustee or private fiduciary manage finances? I'm curious about "The finances are easy" statement.

I would say that if your children are not up to the task of managing the finances, and if they are willing and able to provide other support, then time should be spent educating them on the finances. I say this because I found that managing parental issues was often tied to finances. I needed to know and understand what $$ were available to help make caregiving choices for example. I think it would have been time consuming and frustrating to have to work through a trust company. But maybe that's what people with lots of money do. My parents were far from poor, but they had no such arrangements. I had a global view (finances and health issues, etc) which was important, I think.
If you’re in a facility your healthcare agent will only make healthcare choices for you. Your basic living needs are taken care of. If you opt for in home care, it’s a bit harder to orchestrate.

They charge about one percent and make sense if you have a million dollars. Fiduciaries charge by the hour and are not available in all states. Three hundred for a good one in my area.
delamer
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Re: Solo Seniors: what are you doing to plan for the possibility of dementia/alzheimer's?

Post by delamer »

TimeRunner wrote: Wed Jun 22, 2022 7:16 pm
Lee_WSP wrote: Wed Jun 22, 2022 6:34 pm The "best" plan I have been able to come up with is a CCRC. Even if you have a spouse, a CCRC is still one of the better options as it provides a safety net if your decline is "bad". Relying on your spouse to take care of you places a burden on them, so it's actually a lot easier of a plan than if you weren't solo.

I likewise do not recommend anyone rely upon their children to do it either. Dementia is a horrid disease and its effects range from benign to outright shocking. The end result is always the same. Partial or full assisted living will be necessary.

Medicaid protection trust planning may or may not factor in. Planning your finances is going to be pretty individualized and will depend on a lot of factors.
I manage my elderly Mom's caregiving, healthcare, finances, grocery & supplies shopping, condo maintenance, etc. She wanted more than anything to be able to live out the rest of her life in her condo rather than a facility, and this was after turning down various CCRCs that would have been closer to us than the 85 miles she is from us now. She's living her best life only because she can afford the very expensive 24/7/365 care that's required for her dementia and the problems that come with being 93 and preferring a "bed-centric lifestyle". Although I have everything optimized and as simple as can be arranged, it still takes a fair amount of time almost every day to keep everything on track.

My wife and I were DINKS, so our solution is to be waitlisted at a high quality CCRC that we feel will meet our needs. The waitlist won't get to us for about four years, after which we will hopefully turn down 'offers' for the next six or eight years, assuming we stay healthy enough in the meantime. While that's a bit of a gamble, our lifestyle and family history is such that, accidents aside, we have an excellent chance of still qualifying ten or twelve years from now. In the meantime, we remodeled our current house last year with an eye towards making it 'age-in-place' friendly, so if we had to stay in our house, it's the right size in an excellent location with the right features to allow us to do that, and it hopefully won't require any major maintenance since we replaced the HVAC, roof, plumbing fixtures, etc in the remodel. It should also be easy to sell if/when we do the move to the CCRC.

I haven't yet explored in any depth the issue around finding a fiduciary/trust company, but they are around. It's on my low priority to-do list.
Your mother is fortunate to have you.

But the worrier in me is always concerned when a plan depends on one person being able to handle so much.

If you were hit by the proverbial bus, what would happen to your mother?
One thing that humbles me deeply is to see that human genius has its limits while human stupidity does not. - Alexandre Dumas, fils
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Re: Solo Seniors: what are you doing to plan for the possibility of dementia/alzheimer's?

Post by Flyer24 »

Numerous medical responses were deleted. Stay focused on finance.
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Re: Solo Seniors: what are you doing to plan for the possibility of dementia/alzheimer's?

Post by Circe »

I have an older friend in a CCRC and she's very happy there. It looks like a good solution.

I have a relative who recently passed from Alzheimer's. She stayed home for the first couple of years with the help of relatives, but once she started wandering and getting lost, we had to find a memory care unit. It worked well for the first 5 years at a cost of $480k. After that, she needed 3 years of skilled nursing for a total of $325k. She had pensions and SS that covered most of the costs. The cost of CCRCs doesn't look so bad in light of that.
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Re: Solo Seniors: what are you doing to plan for the possibility of dementia/alzheimer's?

Post by TimeRunner »

delamer wrote: Wed Jun 22, 2022 7:32 pmIf you were hit by the proverbial bus, what would happen to your mother?
It would be a difficult situation since Mom didn't trust my sister to be her backup POA or Health Agent. My sister would make a hash of it if she was involved. My Mom designated a friend about my age as the backup person. That friend manages a similar situation with an Aunt who is now 105 years old - eek. She would be able to take over, but it would be quite a duty to drop into her lap.
One cannot enlighten the unconscious. | "All I need are some tasty waves, a cool buzz, and I'm fine." -Jeff Spicoli
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Re: Solo Seniors: what are you doing to plan for the possibility of dementia/alzheimer's?

Post by GerryL »

Book recommendation: Essential Retirement Planning for Solo Agers: A retirement and aging roadmap for single and childless couples, by Sara Zeff Geber.

I am a life-long solo and, hey, we're all aging. I also have a family history of Alzheimer's. I bought a long-term care policy when I was in my 50s and have more recently been trying to set up my estate plan to cover two possible situations, which I have labeled Dead and Daily.

Dead is easy, relatively. Just need to identify someone to wrap up my affairs. Daily is the real challenge. How can I make arrangements for a time when I might become incapacitated, physically or mentally?

I have organized a team: some close friends, a couple a bit younger than me who live nearby, and my young adult nephew who lives about 1,000 miles away. They have agreed to work as a team. Nephew is named Trustee, friends have role as Trust Protectors. If nephew opts not to be Trustee, the roles are reversed. Of course, it's all academic at this point. And I still have a lot of work to do organizing my papers and documenting my investments and financial plans.

I also keep my eye on local living options if I should need to move out of my house. And I am a member of a virtual village (see village to village network) so I have a sort of community and support group.

Side note: I tried to find a professional fiduciary to include on my team, but I got frustrated and gave up, for now.
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Re: Solo Seniors: what are you doing to plan for the possibility of dementia/alzheimer's?

Post by TN_Boy »

Lee_WSP wrote: Wed Jun 22, 2022 7:30 pm
TN_Boy wrote: Wed Jun 22, 2022 7:24 pm
Lee_WSP wrote: Wed Jun 22, 2022 6:53 pm
FreddieFIRE wrote: Wed Jun 22, 2022 6:47 pm
Lee_WSP wrote: Wed Jun 22, 2022 6:34 pm I likewise do not recommend anyone rely upon their children to do it either. Dementia is a horrid disease and its effects range from benign to outright shocking. The end result is always the same. Partial or full assisted living will be necessary.
What is the "it?" Is it managing the elderly's affairs or actually providing daily care?
The care.

The finances are easy. A trust company if you have the assets. A private fiduciary if you don't. This is my advice even if you have children unless they're very financially savvy. Also, my advice if your spouse may not be up to the task.
I wouldn't recommend children take on daily caregiving itself, unless there is literally no other option. Many children do this, because other options are not available.

But there is still a lot of potential work managing a parent's health issues, housing issues, visiting etc. Such work might not be called "caregiving" but it is important, and can be quite time consuming. This need does not go away even if the parent winds up at the best care facility on the planet. An advocate is needed.

What does it cost to have a trustee or private fiduciary manage finances? I'm curious about "The finances are easy" statement.

I would say that if your children are not up to the task of managing the finances, and if they are willing and able to provide other support, then time should be spent educating them on the finances. I say this because I found that managing parental issues was often tied to finances. I needed to know and understand what $$ were available to help make caregiving choices for example. I think it would have been time consuming and frustrating to have to work through a trust company. But maybe that's what people with lots of money do. My parents were far from poor, but they had no such arrangements. I had a global view (finances and health issues, etc) which was important, I think.
If you’re in a facility your healthcare agent will only make healthcare choices for you. Your basic living needs are taken care of. If you opt for in home care, it’s a bit harder to orchestrate.

They charge about one percent and make sense if you have a million dollars. Fiduciaries charge by the hour and are not available in all states. Three hundred for a good one in my area.
Well, there are healthcare decisions and there are healthcare decisions. If the family member managing the person's care thinks the facility is not good enough and wants to move them to a "better" albeit more expensive facility, I presume the trustee does a bit of due diligence and says "sure, I'll start writing those bigger checks." Along with the cost of moving the person etc.

Or smaller expenses. You buy snacks and other things for person in assisted living. When I did this, I kept records and reimbursed myself (it was typically easier just to use my card for such things). I suppose I have to ask the trustee to reimburse me? If the person has a pet, same question (yes people in assisted living may have pets). Will the trustee go through all the medical bills (coming in months later) from providers that have not properly submitted claims to secondary insurance, contact the provider and tell them to re-submit?

Basically, I'm trying to understand how much overhead the trustee would add to the family member doing the work, plus how much of the "not just writing checks" work they will do.

I confess to not knowing how the taxes will work in a trust arrangement. Does the trustee help with collecting medical receipts and such so that they are itemized? Once in a facility you can generally zero out federal taxes due to large medical deductions. How complicated are the taxes for a trust?

1% on a 1M portfolio is 10k a year. I think that is a lot of money for what is generally the easier part of care management. But if the family member doing all the other work can't handle the finances, I suppose that is okay. It seems to me like a trustee would have made my life quite a bit more painful, but then again, the financial situation I was dealing with (over the 1M threshold) was not that complicated.
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Re: Solo Seniors: what are you doing to plan for the possibility of dementia/alzheimer's?

Post by Lee_WSP »

TN_Boy wrote: Thu Jun 23, 2022 9:36 am Basically, I'm trying to understand how much overhead the trustee would add to the family member doing the work, plus how much of the "not just writing checks" work they will do.

I confess to not knowing how the taxes will work in a trust arrangement. Does the trustee help with collecting medical receipts and such so that they are itemized? Once in a facility you can generally zero out federal taxes due to large medical deductions. How complicated are the taxes for a trust?

1% on a 1M portfolio is 10k a year. I think that is a lot of money for what is generally the easier part of care management. But if the family member doing all the other work can't handle the finances, I suppose that is okay. It seems to me like a trustee would have made my life quite a bit more painful, but then again, the financial situation I was dealing with (over the 1M threshold) was not that complicated.
In your case, a private fiduciary is probably more inline with what you are expecting. In my state, they will do all of the above and act as a conservator would since that is their bread and butter. They’re licensed to be court appointed conservators and guardians. They just also take on private clients.

A trust company may or may not offer those services, you’d have to negotiate with them on that. I can’t give a broad answer on that, but in general they will manage the investments and distribute directly to a checking account or I suppose they could send cash.

As to taxation and distributions, it’s a revocable trust (unless you made a medicaid trust) so the trustee/private fiduciary would distribute according to your wishes when last competent or seemingly competent. The taxes would likewise pass through and there would be no trust tax filing.

There are no perfect or even good solutions to the problem posed in this thread. I just think this is the best solution I’ve been able to come up with given the limitations and realities of cognitive decline.
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Re: Solo Seniors: what are you doing to plan for the possibility of dementia/alzheimer's?

Post by Ranunculus »

Based on my research several years ago, trust companies and bank trust departments that offer the administration of special needs trusts are more likely to offer fiduciary services. It makes sense, the beneficiary of a special needs trust will require more personal oversight by the trust department than someone who is merely receiving a cash distribution each year. A solo senior in need of memory care is essentially a special needs client, so the same criteria should apply in selecting a corporate trustee.
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Re: Solo Seniors: what are you doing to plan for the possibility of dementia/alzheimer's?

Post by TN_Boy »

Lee_WSP wrote: Thu Jun 23, 2022 11:45 am
TN_Boy wrote: Thu Jun 23, 2022 9:36 am Basically, I'm trying to understand how much overhead the trustee would add to the family member doing the work, plus how much of the "not just writing checks" work they will do.

I confess to not knowing how the taxes will work in a trust arrangement. Does the trustee help with collecting medical receipts and such so that they are itemized? Once in a facility you can generally zero out federal taxes due to large medical deductions. How complicated are the taxes for a trust?

1% on a 1M portfolio is 10k a year. I think that is a lot of money for what is generally the easier part of care management. But if the family member doing all the other work can't handle the finances, I suppose that is okay. It seems to me like a trustee would have made my life quite a bit more painful, but then again, the financial situation I was dealing with (over the 1M threshold) was not that complicated.
In your case, a private fiduciary is probably more inline with what you are expecting. In my state, they will do all of the above and act as a conservator would since that is their bread and butter. They’re licensed to be court appointed conservators and guardians. They just also take on private clients.

A trust company may or may not offer those services, you’d have to negotiate with them on that. I can’t give a broad answer on that, but in general they will manage the investments and distribute directly to a checking account or I suppose they could send cash.

As to taxation and distributions, it’s a revocable trust (unless you made a medicaid trust) so the trustee/private fiduciary would distribute according to your wishes when last competent or seemingly competent. The taxes would likewise pass through and there would be no trust tax filing.

There are no perfect or even good solutions to the problem posed in this thread. I just think this is the best solution I’ve been able to come up with given the limitations and realities of cognitive decline.
I wasn't totally clear on my question/comment. My comment is that I don't see a bright line between "spending decisions" and "healthcare decisions." They may be related.

My question is that, if there is a trustee, does a family member doing the work of managing the care for a person have to "get permission" for expenditures from the trustee. One example I gave was the family member wanting to move the person to a higher cost facility. The family member may not be making that call; it's the care manager. Another question, if I pay for something out of my own pocket, how much trouble is it to get "reimbursed." I.e. do I I need to keep receipts and such to present to the trustee? And I also asked if there is a question about the medical billing, who sorts that out, the person writing the checks or the person doing the care managing? Would the trustee do or help with the tax management? It seems like the trustee, the person managing the investments and such would almost have to do that ... but there is a lot more work than just collecting 1099s here.

I didn't quite get a feel for the answer from your response. I'm asking because at least in my situation, it would have made my life more painful if I was always having to go to the trustee to ask for money. That's really the key question I'm asking and it is important if you have a situation where one person is managing the care and doing the work, and somebody else handling the finances. I get that the trustee manages the investments. But exactly who is making the spending decisions? The trustee or the care manager?

I am not saying any of this is a bad idea, I genuinely would like to understand how this would work in practice.
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Re: Solo Seniors: what are you doing to plan for the possibility of dementia/alzheimer's?

Post by TN_Boy »

Ranunculus wrote: Thu Jun 23, 2022 12:55 pm Based on my research several years ago, trust companies and bank trust departments that offer the administration of special needs trusts are more likely to offer fiduciary services. It makes sense, the beneficiary of a special needs trust will require more personal oversight by the trust department than someone who is merely receiving a cash distribution each year. A solo senior in need of memory care is essentially a special needs client, so the same criteria should apply in selecting a corporate trustee.
That's an interesting point, how much would management of a "special needs trust" cost?
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Re: Solo Seniors: what are you doing to plan for the possibility of dementia/alzheimer's?

Post by Lee_WSP »

TN_Boy wrote: Thu Jun 23, 2022 6:59 pm
Ranunculus wrote: Thu Jun 23, 2022 12:55 pm Based on my research several years ago, trust companies and bank trust departments that offer the administration of special needs trusts are more likely to offer fiduciary services. It makes sense, the beneficiary of a special needs trust will require more personal oversight by the trust department than someone who is merely receiving a cash distribution each year. A solo senior in need of memory care is essentially a special needs client, so the same criteria should apply in selecting a corporate trustee.
That's an interesting point, how much would management of a "special needs trust" cost?
It does not typically cost more or only a quarter point or so more, it’s just that only a few companies even offer such services.
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Re: Solo Seniors: what are you doing to plan for the possibility of dementia/alzheimer's?

Post by Lee_WSP »

TN_Boy wrote: Thu Jun 23, 2022 6:58 pm
Lee_WSP wrote: Thu Jun 23, 2022 11:45 am
TN_Boy wrote: Thu Jun 23, 2022 9:36 am Basically, I'm trying to understand how much overhead the trustee would add to the family member doing the work, plus how much of the "not just writing checks" work they will do.

I confess to not knowing how the taxes will work in a trust arrangement. Does the trustee help with collecting medical receipts and such so that they are itemized? Once in a facility you can generally zero out federal taxes due to large medical deductions. How complicated are the taxes for a trust?

1% on a 1M portfolio is 10k a year. I think that is a lot of money for what is generally the easier part of care management. But if the family member doing all the other work can't handle the finances, I suppose that is okay. It seems to me like a trustee would have made my life quite a bit more painful, but then again, the financial situation I was dealing with (over the 1M threshold) was not that complicated.
In your case, a private fiduciary is probably more inline with what you are expecting. In my state, they will do all of the above and act as a conservator would since that is their bread and butter. They’re licensed to be court appointed conservators and guardians. They just also take on private clients.

A trust company may or may not offer those services, you’d have to negotiate with them on that. I can’t give a broad answer on that, but in general they will manage the investments and distribute directly to a checking account or I suppose they could send cash.

As to taxation and distributions, it’s a revocable trust (unless you made a medicaid trust) so the trustee/private fiduciary would distribute according to your wishes when last competent or seemingly competent. The taxes would likewise pass through and there would be no trust tax filing.

There are no perfect or even good solutions to the problem posed in this thread. I just think this is the best solution I’ve been able to come up with given the limitations and realities of cognitive decline.
I wasn't totally clear on my question/comment. My comment is that I don't see a bright line between "spending decisions" and "healthcare decisions." They may be related.

My question is that, if there is a trustee, does a family member doing the work of managing the care for a person have to "get permission" for expenditures from the trustee. One example I gave was the family member wanting to move the person to a higher cost facility. The family member may not be making that call; it's the care manager. Another question, if I pay for something out of my own pocket, how much trouble is it to get "reimbursed." I.e. do I I need to keep receipts and such to present to the trustee? And I also asked if there is a question about the medical billing, who sorts that out, the person writing the checks or the person doing the care managing? Would the trustee do or help with the tax management? It seems like the trustee, the person managing the investments and such would almost have to do that ... but there is a lot more work than just collecting 1099s here.

I didn't quite get a feel for the answer from your response. I'm asking because at least in my situation, it would have made my life more painful if I was always having to go to the trustee to ask for money. That's really the key question I'm asking and it is important if you have a situation where one person is managing the care and doing the work, and somebody else handling the finances. I get that the trustee manages the investments. But exactly who is making the spending decisions? The trustee or the care manager?

I am not saying any of this is a bad idea, I genuinely would like to understand how this would work in practice.
You can set it up however you’d like. But the care manager would choose the facility, the trustee just deposits the funds or allows the auto withdrawal.

Reimbursements are more complicated. You really shouldn’t do that. But you in your personal capacity can still gift or reimburse whoever you want so long as you’re competent.
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Re: Solo Seniors: what are you doing to plan for the possibility of dementia/alzheimer's?

Post by TN_Boy »

Lee_WSP wrote: Thu Jun 23, 2022 8:48 pm
TN_Boy wrote: Thu Jun 23, 2022 6:58 pm
Lee_WSP wrote: Thu Jun 23, 2022 11:45 am
TN_Boy wrote: Thu Jun 23, 2022 9:36 am Basically, I'm trying to understand how much overhead the trustee would add to the family member doing the work, plus how much of the "not just writing checks" work they will do.

I confess to not knowing how the taxes will work in a trust arrangement. Does the trustee help with collecting medical receipts and such so that they are itemized? Once in a facility you can generally zero out federal taxes due to large medical deductions. How complicated are the taxes for a trust?

1% on a 1M portfolio is 10k a year. I think that is a lot of money for what is generally the easier part of care management. But if the family member doing all the other work can't handle the finances, I suppose that is okay. It seems to me like a trustee would have made my life quite a bit more painful, but then again, the financial situation I was dealing with (over the 1M threshold) was not that complicated.
In your case, a private fiduciary is probably more inline with what you are expecting. In my state, they will do all of the above and act as a conservator would since that is their bread and butter. They’re licensed to be court appointed conservators and guardians. They just also take on private clients.

A trust company may or may not offer those services, you’d have to negotiate with them on that. I can’t give a broad answer on that, but in general they will manage the investments and distribute directly to a checking account or I suppose they could send cash.

As to taxation and distributions, it’s a revocable trust (unless you made a medicaid trust) so the trustee/private fiduciary would distribute according to your wishes when last competent or seemingly competent. The taxes would likewise pass through and there would be no trust tax filing.

There are no perfect or even good solutions to the problem posed in this thread. I just think this is the best solution I’ve been able to come up with given the limitations and realities of cognitive decline.
I wasn't totally clear on my question/comment. My comment is that I don't see a bright line between "spending decisions" and "healthcare decisions." They may be related.

My question is that, if there is a trustee, does a family member doing the work of managing the care for a person have to "get permission" for expenditures from the trustee. One example I gave was the family member wanting to move the person to a higher cost facility. The family member may not be making that call; it's the care manager. Another question, if I pay for something out of my own pocket, how much trouble is it to get "reimbursed." I.e. do I I need to keep receipts and such to present to the trustee? And I also asked if there is a question about the medical billing, who sorts that out, the person writing the checks or the person doing the care managing? Would the trustee do or help with the tax management? It seems like the trustee, the person managing the investments and such would almost have to do that ... but there is a lot more work than just collecting 1099s here.

I didn't quite get a feel for the answer from your response. I'm asking because at least in my situation, it would have made my life more painful if I was always having to go to the trustee to ask for money. That's really the key question I'm asking and it is important if you have a situation where one person is managing the care and doing the work, and somebody else handling the finances. I get that the trustee manages the investments. But exactly who is making the spending decisions? The trustee or the care manager?

I am not saying any of this is a bad idea, I genuinely would like to understand how this would work in practice.
You can set it up however you’d like. But the care manager would choose the facility, the trustee just deposits the funds or allows the auto withdrawal.

Reimbursements are more complicated. You really shouldn’t do that. But you in your personal capacity can still gift or reimburse whoever you want so long as you’re competent.
So basically the trustee (will? has to?) go along with the care manager recommendations on spending? You can set a trust that says basically, "the trustee manages the investments [in some specified manner] and will disburse funds as requested by the care manager(s)?" And again, if the care manager said "we need to move person to a higher cost facility, or pay for additional care at the facility, the trustee just says yes?"

Also still unclear on the handling of things like medical billing.

Didn't understand your answer on reimbursements. The scenario I have in mind is care manager picks up a few things for person in facility. It can often be easier to pay for this using care manager credit card. How would you recommend this scenario be handled? In my case, it was pretty frequent.

Again, I'm not arguing the trust is a bad idea, I'm just trying to understand precisely how the working relationship is defined. From my experience I can see multiple potential problems. Obviously there can be problems with or without a trustee (e.g. children that disagree on what should be done) but the trustee is not the one doing the care managing.
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Re: Solo Seniors: what are you doing to plan for the possibility of dementia/alzheimer's?

Post by Lee_WSP »

TN_Boy wrote: Thu Jun 23, 2022 9:01 pm [
So basically the trustee (will? has to?) go along with the care manager recommendations on spending? You can set a trust that says basically, "the trustee manages the investments [in some specified manner] and will disburse funds as requested by the care manager(s)?" And again, if the care manager said "we need to move person to a higher cost facility, or pay for additional care at the facility, the trustee just says yes?"

Also still unclear on the handling of things like medical billing.

Didn't understand your answer on reimbursements. The scenario I have in mind is care manager picks up a few things for person in facility. It can often be easier to pay for this using care manager credit card. How would you recommend this scenario be handled? In my case, it was pretty frequent.

Again, I'm not arguing the trust is a bad idea, I'm just trying to understand precisely how the working relationship is defined. From my experience I can see multiple potential problems. Obviously there can be problems with or without a trustee (e.g. children that disagree on what should be done) but the trustee is not the one doing the care managing.
The trust we’d have to setup during life is a revocable trust or an irrevocable Medicaid trust. If you go the Medicaid route, you are stuck with whatever Medicaid allows. It’s purely to ensure your assets pass to heirs.

If revocable then you’d usually have a provision saying you should get priority over all other beneficiaries, thus unless there’s a question of money running out, the expenses ought to be approved.
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Re: Solo Seniors: what are you doing to plan for the possibility of dementia/alzheimer's?

Post by TN_Boy »

Lee_WSP wrote: Thu Jun 23, 2022 9:35 pm
TN_Boy wrote: Thu Jun 23, 2022 9:01 pm [
So basically the trustee (will? has to?) go along with the care manager recommendations on spending? You can set a trust that says basically, "the trustee manages the investments [in some specified manner] and will disburse funds as requested by the care manager(s)?" And again, if the care manager said "we need to move person to a higher cost facility, or pay for additional care at the facility, the trustee just says yes?"

Also still unclear on the handling of things like medical billing.

Didn't understand your answer on reimbursements. The scenario I have in mind is care manager picks up a few things for person in facility. It can often be easier to pay for this using care manager credit card. How would you recommend this scenario be handled? In my case, it was pretty frequent.

Again, I'm not arguing the trust is a bad idea, I'm just trying to understand precisely how the working relationship is defined. From my experience I can see multiple potential problems. Obviously there can be problems with or without a trustee (e.g. children that disagree on what should be done) but the trustee is not the one doing the care managing.
The trust we’d have to setup during life is a revocable trust or an irrevocable Medicaid trust. If you go the Medicaid route, you are stuck with whatever Medicaid allows. It’s purely to ensure your assets pass to heirs.

If revocable then you’d usually have a provision saying you should get priority over all other beneficiaries, thus unless there’s a question of money running out, the expenses ought to be approved.
I need to look up more about revocable trusts. Often, I gather, a revocable trust would be set up with maybe a family member stepping in if the holder of the trust can no longer manage things. This seems similar to having a family member with financial POA. In my case, I had financial and medical POA, and I just stepped in when needed.

To recap, the specific question I had here was when the family member doing care management/helping etc was not trustee but instead was a bank or some other institution. And I simply wasn't (and remain) unclear on how the interaction between trustee and the person actually making the decisions can work.

Could/should you have the trust document worded something like "if I cannot function as trustee then the [financial institution] should accept the recommendations of [family member named] as to how money is spent on my care." In this case the financial institution is indeed managing the money but where it goes is not up to them. Alternatively, you could have the financial institution act as a gatekeeper, but if that is the case, I could see opportunities for friction. And the questions I had about the tax management, medical bills management, etc remain. Obviously this problem has been solved in the past, I'm just wondering sort of how the trust documents would cover that.

As the care manager and POA, I basically did what I wanted. The potential for abuse in such a situation is obvious, though, so I could see where someone might want an independent trustee. It's a difficult question, but I would argue for very careful consideration of what the trust instructions are to handle this situation without making the life of the care manager miserable. A financial institution is not in a good position to make many care decisions.
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Re: Solo Seniors: what are you doing to plan for the possibility of dementia/alzheimer's?

Post by Mudpuppy »

Lee_WSP wrote: Wed Jun 22, 2022 6:53 pm
FreddieFIRE wrote: Wed Jun 22, 2022 6:47 pm
Lee_WSP wrote: Wed Jun 22, 2022 6:34 pm I likewise do not recommend anyone rely upon their children to do it either. Dementia is a horrid disease and its effects range from benign to outright shocking. The end result is always the same. Partial or full assisted living will be necessary.
What is the "it?" Is it managing the elderly's affairs or actually providing daily care?
The care.

The finances are easy. A trust company if you have the assets. A private fiduciary if you don't. This is my advice even if you have children unless they're very financially savvy. Also, my advice if your spouse may not be up to the task.
As a childless adult who is currently the nighttime caregiver and medical logistics coordinator for an elderly relative, I am watching this thread with interest because I do not want to burden my nieces and nephews with the same tasks for me when my time comes. This relative does not have the resources to afford anything else though, so it's up to the family (another family member manages the physical caregiving during the daytime so I can work, run errands, etc. and only have to take time off for medical appointments).

From this thread, I'll hope that CCRCs still exist when I get older, and that they are still staffed sufficiently to provide appropriate physical and mental care. My family history is such that physical decline usually greatly precedes mental decline, so quality of caregiving is of prime importance to me. I will likely need help with ADLs long before my mind decays. I'll also look into fiduciary services and healthcare managers.

My main concern is avoiding predators out for my resources, particularly since there's a prevailing bias that physically frail is the same as mentally frail, when that is not always the case. There was an extensive problem in a nearby state of predatory "conservators" essentially stealing the resources of wealthy elders in such facilities, even ones who had active family caregivers, through corruption of the court-appointed conservator process. They'd get themselves appointed by the courts as conservator (through falsified medical and other statements), move the elders to far cheaper and more poorly run facilities without disclosing their new location to their friends and family members, and then drain their finances dry. It makes me wonder how one can protect oneself from being a victim to a similar situation.
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Re: Solo Seniors: what are you doing to plan for the possibility of dementia/alzheimer's?

Post by montanagirl »

I figured on moving to a CCRC eventually but my husband is 10 years older than I and probably should be in one now at 83 but I don't feel ready of course.

Right now I wonder about these places' ability to stay staffed. A friend is in an independent living "manor" and they are down to one meal a day because they can't find kitchen staff. They could lose their HUD certification.

It's bad enough that there are no real standards for the aides, aside from the actual nurses. Anyone can get hired right now. :o
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Re: Solo Seniors: what are you doing to plan for the possibility of dementia/alzheimer's?

Post by M.Lee »

Mudpuppy wrote: Sun Jun 26, 2022 1:14 pm My main concern is avoiding predators out for my resources, particularly since there's a prevailing bias that physically frail is the same as mentally frail, when that is not always the case. There was an extensive problem in a nearby state of predatory "conservators" essentially stealing the resources of wealthy elders in such facilities, even ones who had active family caregivers, through corruption of the court-appointed conservator process. They'd get themselves appointed by the courts as conservator (through falsified medical and other statements), move the elders to far cheaper and more poorly run facilities without disclosing their new location to their friends and family members, and then drain their finances dry. It makes me wonder how one can protect oneself from being a victim to a similar situation.
This is precisely my concern and it literally keeps me up at night sometimes. So far on this thread I haven't read from a poster that has zero family. That's my situation.

When this subject is brought up in discussion, people usually suggest seeing an attorney, getting a power of attorney, etc. As you mentioned above, court appointed conservators can be evil. And really, by the time you need one how will you go about getting one. It's a horrible situation for the elderly senior alone.

I would not even consider a CCRC because what you see now may be completely different later on, as poster MontanaGirl writes. I guess I am hoping that I die before I get to the point of needing this kind of help (seriously).
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Re: Solo Seniors: what are you doing to plan for the possibility of dementia/alzheimer's?

Post by Lee_WSP »

Mudpuppy wrote: Sun Jun 26, 2022 1:14 pm My main concern is avoiding predators out for my resources, particularly since there's a prevailing bias that physically frail is the same as mentally frail, when that is not always the case. There was an extensive problem in a nearby state of predatory "conservators" essentially stealing the resources of wealthy elders in such facilities, even ones who had active family caregivers, through corruption of the court-appointed conservator process. They'd get themselves appointed by the courts as conservator (through falsified medical and other statements), move the elders to far cheaper and more poorly run facilities without disclosing their new location to their friends and family members, and then drain their finances dry. It makes me wonder how one can protect oneself from being a victim to a similar situation.
Move to a state with better protections and have family members willing and able to serve as conservator in case it comes to that. It’s a lot harder without children. Alternatively, pick your conservator beforehand.

There’s not a lot of great choices, but you can throw up some safeguards.
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Re: Solo Seniors: what are you doing to plan for the possibility of dementia/alzheimer's?

Post by delamer »

montanagirl wrote: Sun Jun 26, 2022 4:54 pm I figured on moving to a CCRC eventually but my husband is 10 years older than I and probably should be in one now at 83 but I don't feel ready of course.

Right now I wonder about these places' ability to stay staffed. A friend is in an independent living "manor" and they are down to one meal a day because they can't find kitchen staff. They could lose their HUD certification.

It's bad enough that there are no real standards for the aides, aside from the actual nurses. Anyone can get hired right now. :o
I’m not surprised to hear that CCRCs are suffering from the same staffing issues as other employers.

But if you are still considering one, you need to get on a waitlist as soon as possible. Waitlists allow don’t require a commitment, to my knowledge.
One thing that humbles me deeply is to see that human genius has its limits while human stupidity does not. - Alexandre Dumas, fils
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Lee_WSP
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Re: Solo Seniors: what are you doing to plan for the possibility of dementia/alzheimer's?

Post by Lee_WSP »

M.Lee wrote: Sun Jun 26, 2022 5:08 pm
When this subject is brought up in discussion, people usually suggest seeing an attorney, getting a power of attorney, etc. As you mentioned above, court appointed conservators can be evil. And really, by the time you need one how will you go about getting one. It's a horrible situation for the elderly senior alone.
By the time you need a conservator or are close to it, you are far too gone mentally to know what or who to turn to for help. You need to figure it out today and update it constantly. Your chosen agents usually have first priority, so naming good agents is a first line defense. Second line is to figure out a trustworthy third party to nominate beforehand who is unlikely to predecease.
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Re: Solo Seniors: what are you doing to plan for the possibility of dementia/alzheimer's?

Post by delamer »

M.Lee wrote: Sun Jun 26, 2022 5:08 pm
Mudpuppy wrote: Sun Jun 26, 2022 1:14 pm My main concern is avoiding predators out for my resources, particularly since there's a prevailing bias that physically frail is the same as mentally frail, when that is not always the case. There was an extensive problem in a nearby state of predatory "conservators" essentially stealing the resources of wealthy elders in such facilities, even ones who had active family caregivers, through corruption of the court-appointed conservator process. They'd get themselves appointed by the courts as conservator (through falsified medical and other statements), move the elders to far cheaper and more poorly run facilities without disclosing their new location to their friends and family members, and then drain their finances dry. It makes me wonder how one can protect oneself from being a victim to a similar situation.
This is precisely my concern and it literally keeps me up at night sometimes. So far on this thread I haven't read from a poster that has zero family. That's my situation.

When this subject is brought up in discussion, people usually suggest seeing an attorney, getting a power of attorney, etc. As you mentioned above, court appointed conservators can be evil. And really, by the time you need one how will you go about getting one. It's a horrible situation for the elderly senior alone.

I would not even consider a CCRC because what you see now may be completely different later on, as poster MontanaGirl writes. I guess I am hoping that I die before I get to the point of needing this kind of help (seriously).
I’m sympathetic to your situation.

But once you’ve ruled out all reasonable — albeit imperfect — possible solutions to a problem, all you are left with is worry.
One thing that humbles me deeply is to see that human genius has its limits while human stupidity does not. - Alexandre Dumas, fils
Zonian59
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Re: Solo Seniors: what are you doing to plan for the possibility of dementia/alzheimer's?

Post by Zonian59 »

This is a very significant discussion that I'm trying to figure out.....while I'm still have cognizance. I can't help thinking there's a big train wreck in the making.

I am a solo male ager/senior at age 63 having no siblings, no spouse, family, children, relatives. My father passed away decades ago and my mother just recently passed away at age 95 from Dementia/Alzheimer's. I was her only child and only immediate relative and spent the last ten years as her caregiver as she didn't want to be cared for by strangers or living in a nursing home. So she lived with me and I had part-time caregiver help, but my mother had trust issues with them. When I retired five years ago, I transitioned to a solo full-time caregiver and cared for her until she died. Now I'm concerned about that soon-to-happen train wreck. Have few friends.

I have a real concern about dementia/alzheimers' eventually catching up to me and how I will get things in order, particular finances. Fortunately my house is fully paid off and I have savings and investments equivalent to about 35x expenses.
I'm still l in relative good health, but I anticipate that will change within the next 10-12 years.
But I still have no fully defined Will, Trusts, etc. because of a lack of Trustee and Beneficiaries in mind.
Then there's the POA and medical and financials. Again no one in mind. I have a credit union, bank and brokerage and I've met the branch managers and staff and talked about Corporate Trust Services. They don't seem interested in providing the service.

Most of the books referenced and responses here mentions reliance on some relatives and having a will, trust, estate plan with a designated POA, Trustee, Beneficiaries, etc. But what if you have nobody? Literally nobody to count on as a safety net? What are the options, if any?
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Re: Solo Seniors: what are you doing to plan for the possibility of dementia/alzheimer's?

Post by Zonian59 »

M.Lee wrote: Sun Jun 26, 2022 5:08 pm
Mudpuppy wrote: Sun Jun 26, 2022 1:14 pm My main concern is avoiding predators out for my resources, particularly since there's a prevailing bias that physically frail is the same as mentally frail, when that is not always the case. There was an extensive problem in a nearby state of predatory "conservators" essentially stealing the resources of wealthy elders in such facilities, even ones who had active family caregivers, through corruption of the court-appointed conservator process. They'd get themselves appointed by the courts as conservator (through falsified medical and other statements), move the elders to far cheaper and more poorly run facilities without disclosing their new location to their friends and family members, and then drain their finances dry. It makes me wonder how one can protect oneself from being a victim to a similar situation.
This is precisely my concern and it literally keeps me up at night sometimes. So far on this thread I haven't read from a poster that has zero family. That's my situation.

When this subject is brought up in discussion, people usually suggest seeing an attorney, getting a power of attorney, etc. As you mentioned above, court appointed conservators can be evil. And really, by the time you need one how will you go about getting one. It's a horrible situation for the elderly senior alone.

I would not even consider a CCRC because what you see now may be completely different later on, as poster MontanaGirl writes. I guess I am hoping that I die before I get to the point of needing this kind of help (seriously).
I have zero family. What is also bothering me is that I inherited some valuable stuff from my parents as well as accumulated my own stuff that I'm trying to find homes for before I die. That's another issue solo seniors face: What to do with valuable possessions when you have no children or relatives to pass them on to.
montanagirl
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Re: Solo Seniors: what are you doing to plan for the possibility of dementia/alzheimer's?

Post by montanagirl »

delamer wrote: Sun Jun 26, 2022 5:19 pm
montanagirl wrote: Sun Jun 26, 2022 4:54 pm I figured on moving to a CCRC eventually but my husband is 10 years older than I and probably should be in one now at 83 but I don't feel ready of course.

Right now I wonder about these places' ability to stay staffed. A friend is in an independent living "manor" and they are down to one meal a day because they can't find kitchen staff. They could lose their HUD certification.

It's bad enough that there are no real standards for the aides, aside from the actual nurses. Anyone can get hired right now. :o
I’m not surprised to hear that CCRCs are suffering from the same staffing issues as other employers.

But if you are still considering one, you need to get on a waitlist as soon as possible. Waitlists allow don’t require a commitment, to my knowledge.

I just realized that many here have access to CCRCs that are more like the Villages and you buy a house or condo? And residents are really active?

Whereas here all we have here are fancy assisted living centers built about 20 years ago with just apartments, and attached nursing home (I think). You can start as independent living of course.

And it seems like once someone moves in you rarely see them again. Over the years I've gotten to know a lot of older people and it keeps happening like that. People who were vigorous and active in the community.

Maybe it's a coincidence. But what I'm afraid of is that once everything is being done for you, like meals, you just kinda give up. So I am reluctant to start the ball rolling.

Would the limited options make a difference to anyone else?
Nowizard
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Re: Solo Seniors: what are you doing to plan for the possibility of dementia/alzheimer's?

Post by Nowizard »

Our view is to roll that concern into other, progressive health issues. We have no LTC insurance but would either choose home care if we could fund it or, more likely, moving to a comprehensive senior care facility with independent living, assisted care, nursing home and memory care units. Though often expensive to enter, some have appealing service costs for the more involved care financially, and there are substantial tax deductions accompanying those costs. This issue also faces couples, though the circumstances and timing may differ from a solo person.

Tim
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